HOLY ANGEL UNIVERSITY

School of Nursing and Allied Medical Sciences

Department of Nursing

HGT Monitoring Rubric

Name: Date:
Section:

Steps Met Unmet Comments

1. Verify the order in the Doctor’s order sheet.
2. Gather supplies and assemble: clean gloves,
glucometer, lancet, strip, alcohol swab, dry cotton,
sharps container.
3. Wash hands. Dry hands with a tissue paper or hand
towel.
4. Provide privacy. Introduce yourself and explain what
you will be doing.
5. Confirm patient’s identity.
6. Verify if the patient had a meal or not prior the test.
(Ideally, the testing should be done first: T-I-E).
7. Wear gloves.
8. Allow patient to wash his/her hands with soap and
water, if able. If unable, wipe finger with alcohol swab
and allow to air dry.
9. Open the Test Strip vial and take one new test strip out
of the vial and recap the vial quickly and firmly.
10. Make sure not to touch the test pad portion of the
reagent strip.
11. While the meter is off, insert the test strip into the
meter’s strip slot in the right direction (the meter will
turn on with a full screen display of an icon of a drop of
blood.
*If NO action is taken in 2 minutes, the meter will
turn off automatically.
12. Select a finger to puncture.
13. Ask patient for preference.
14. Use a new lancet and apply it to the side of the tip of
the chosen finger and let it puncture the skin.
(Discard in sharp container if within reach).
 15. Swiftly wipe the first drop of blood with a dry cotton.
16. Gently squeeze below the puncture site and ensure
that it forms a round of blood. Apply it to the top of
the test strip.
17. Once blood is detected, retract finger and apply light
pressure with a dry cotton on the puncture site.
18. Once result is obtained, remove the used strip by hand
or ejector button.
19. Discard used lancet and strip in sharp container.
20. Remove gloves and wash hands.
21. Document the result.
Personal and Professional Attributes
1. Wears complete uniform & is well-groomed
2. Observes manners and courtesies.
3. Work station is clean.
4. Demonstrates confidence and knowledge in
performing the procedure.

RATING:

Evaluator’s Signature over Printed Name Student’s Signature over Printed Name
Date: Date: